The MetroHealth System

MetroHealth10/04/2017 Revdex.com, Inc. 2800 Euclid Ave, 4th Floor Cleveland, OH 44115-2408 To whom it may concern: Complaint ID [redacted]: This letter is in response to the correspondence received by the Revdex.com in our Office of Patient Relations on 09/28/2017. The following...

information is being provided to address the issue{s) that have been brought to our attention. Customer Feedback Issue: You reported the following concern(s): 09/28/2017: Patient [redacted] reported potential issues with billing for services rendered in November 2016. Investigation Process: All outstanding balances were reviewed to verify accuracy of the charges and billing of the claims to the insurance company. The documentation in the patient's medical record supports the type of service that was billed on the claim to the patient's insurance company, a medical office visit versus and preventive office visit. The patient's insurance provides preventive visits payable at 100% of the allowable, this visit does not support billing as preventive_ The patient's insurance company was called on 10/4/2017 to verify if the vaccine the patient received was processed correctly, Per the representative at the insurance company, this service is going to be sent for reprocessing, potentially, without patient responsibility, allow 30 business day. The patient will receive an updated explanation of benefits when the claim is reprocessed. Resolution: MetroHealth originally billed as a medical office visit, documentation does not support a change to a preventive. The patient will be responsible for the $30.00 physician copay and the $136_92 of the current $192.79 on the hospital charges. The $56.48 patient responsibility for the vaccine could change once the claim is reprocessed. Hospital Contact end Telephone Number: Shannon T[redacted] Thank you for bringing this matter to my attention. It is our goal to provide each of our patients with the highest possible quality of medical and hospital services. If you should need any further assistance with this issue, please do not hesitate to contact me. Sincerely, Shannon T[redacted] Supervisor, Customer Service Advocacy [redacted]

This letter is in response to the message that you made to our Office of Patient Relations on 10/21/2015. The following information is being provided to address the issue(s) brought to our attention.
Customer Feedback Issue: You reported the following concern(s): Patient visited MetroHealth for...

preventive care but was billed for both a preventive care and diagnostic office visit.
Investigation Process:
10/22/2015: The MetroHeath System reviewed the accuracy of the charges. It was determined that the documentation did not support the billing of a medical office visit in conjunction with the preventive office visit.
Resolution: 10/22/2015: The medical office visit charges were removed from the account. The services are being rebilled to insurance for the correct charges. The patient and the patient's husband have been notified of the resolution.
Hospital Contact and Telephone Number:
[redacted]
Thank you for bringing this matter to my attention. It is our goal to provide each of our patients with the highest possible quality of medical and hospital services. If you should need any further assistance with this issue, please do not hesitate to contact me.
Sincerely,
[redacted]
Customer Service Advocacy Team [redacted]

I have reviewed the response made by the business in reference to complaint ID [redacted], and have determined that this does not resolve my complaint.  For your reference, details of the offer I reviewed appear below.
Once again, there is no mention of the $241.00 Clinic Visit charge, for which I now know that my insurance company has not seen a claim filed.  Though Metro believes they have not billed incorrectly, what I am saying - what keeps getting missed in their responses and why I'm so angry about this - is that I was told by 3 people over the phone that the Clinic Charge of $241.00 is literally for being in the room I was examined in.  This is a gross and blatant over charge and is unacceptable.  I refuse to be charged such exorbitant amounts for simply occupying a room within their clinic.  I have attached the bill in question - please note that there are 2 charges under Hospital Services - one is for radiology and the other is the Clinic Visit.  As my insurance company has seen and adjusted the amount for the radiology visit, that leaves the Clinic Visit piece of it which this hospital refuses to acknowledge in writing.  So I am sending it to you there at the Revdex.com so you can see for yourself.  If this truly were for radiology I wouldn't say anything - I understand that equipment and machinery such as that costs something to operate.  I am disputing the Clinic Visit charge, which Metro refuses to acknowledge, and I refuse to pay for because it is ridiculous.  Metro continues to respond to my complaints with an explanation of how my insurance works.  I can assure Metro and the Revdex.com that I fully understand how insurance works.  I am simply not rolling over and paying any old bill that Metro seems to believe I owe them for whatever reasons they wish to concoct.  Unless they can produce a document which I have signed authorizing them to charge me for occupying their room in this ridiculous amount, they should remove this charge from my bill because it's outrageous and everything that is wrong with healthcare these days, if a person is charged $241 to simply be in a room.
Regards,
[redacted]

MetroHealth 2/19/2016 Revdex.com, Inc 2800 Euclid Ave, 4th Floor Cleveland, OH 44115-2408 Fax: 216-861-6365 To whom it may concern: This letter is in response to the email your office sent to MetroHealth's Office of Patient Relations on 2/15/2016. The...

following information is being provided to address the issue(s) brought to our attention. Customer Feedback Issue: You reported the following concern from our patient(s): Patient [redacted]: "I received a bill from MetroHealth for $5.00 for a service I received on June 29, 2015. I paid the $5.00 copay at the time of service. My explanation of benefits (EOB) shows that I only owe the $5.00. MetroHealth sent me a bill for this date of service three (3) times and I called every time and explained that I already paid. They then sent me to collections for the bill. I have had a few correspondence with the collection agency and they finally sent me verification of the debt. The verification shows that I only owed $5.00 out of pocket, which I have a receipt for and provided to them. I had received numerous bills from MetroHealth last year which they ended up adjusting since 1 had already paid, or they did not apply the insurance adjustment before sending the bill." Investigation Process: Steps taken to resolve issue(s): The patient's account was reviewed. The patient did make her copay at the time of service, on 6/29/2015. The hospital account showed a balance due because the copay sitting on the patient's physician account, that has been corrected and applied to the hospital account. It was also reviewed why a contractual adjustment was not posted to a November 2015 date of service. The file we received to post the remit electronically had the incorrect code in the file, which moved the balance from insurance liability to patient responsibility in error. Resolution: Final result and date completed: The patient's accounts for both dates of service, 6/29/15 and 11/2015 has been corrected and show a zero patient responsibility. MetroHealth is currently in the processes of updating our workflow to catch the unapplied copays, and make sure the money is applied before a statement is mailed to the patient. Hospital Contact and Telephone Number: Shannon Thomas, Supervisor Customer Service Advocacy 216-957-3258 Thank you for bringing this matter to our attention. It is our goal to provide each of our patients with the highest possible quality of medical and hospital services. If you should need any further assistance with this issue, please do not hesitate to contact me at the telephone number provided above. Sincerely, Shannon  T[redacted]

This letter is in response to the message that you made to our Office of Patient Relations on 6/16/2015. The following information is being provided to address the issue(s) brought to our attention.Customer Feedback issue:You reported the following concern(s):6/17/2015: Patient [redacted]...

believes that his outstanding hospital balances were referred to collections in error. Mr. [redacted] would like his balances returned from collections to continue to pay the remaining balances directly to MetroHealth.Investigation Process: 6/17/2015: The MetroHeath System verified the accuracy of the balances due. All outstanding balances are correct per explanation of benefits from the patient's insurance companies.The MetroHealth selfpay billing process is as follows: the patient will get three (3) statements on any account number. After the 3 billing statements if there is any balance outstanding, they are moved to our collection agency to assist us with the collection process. The second and third statements have warning messages. The second statement will remind the patient they are ‘past due‘ and the third statement will remind the patient ‘paying in full will avoid collections referral.‘ Resolution:6/17/2015: l spoke to Mr. [redacted] on 6/17/2015. During this call he had other outstanding questions which required additional follow up. I had those issues reviewed and left a message for the patient to call me back. l will advise the patient that his balances will be returned to from the agency and will set him up on the payment plan he is requesting. l am also sending the" patient the attached letter.We are also in the process of updating our statements to make sure that it is clear for our patients that payment plan options are available. Hospital Contact and Telephone Number:[redacted]Thank you for bringing this matter to my attention. lt is our goal to provide each of our patients with the highest possible quality of medical and hospital services. If you should need any further assistance with this issue, please do not hesitate to contact me.Sincerely,[redacted]  [redacted]Customer Service[redacted]

This letter is in response to the correspondence received by the Revdex.com in our Office of Patient Relations on 7/01/2015.  The following information is being provided to address the issue(s) that have been brought to our attention.Customer Feedback Issue:  You reported the following...

concern(s):  7/01/2015: Patient [redacted] reported potential issues with billing for services rendered at the Middleburg Heights November Family Medical Center and lack of resolution on previous call attempts.Investigation Process: All outstanding balances were reviewed to verify accuracy of the charges and billing of the claims to the insurance company.  The representatives Ms. [redacted] had previously spoken to were coached on how the calls should have been handled.Resolution: A complete review of all Ms. [redacted]’s issues were reviewed.  All charges were billed correctly to her insurance company based on her medical record.  All balances due are a result of the patients out of pocket medical costs.  We are working with Ms. [redacted] to explain charges and a potential payment plan regarding her outstanding balances. Hospital Contact and Telephone Number:  [redacted]Thank you for bringing this matter to my attention. It is our goal to provide each of our patients with the highest possible quality of medical and hospital services. If you should need any further assistance with this issue, please do not hesitate to contact me.Sincerely,[redacted]Customer Service[redacted]